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General NPI Number Information
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NPI Number | 1366050007
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Entity Type | Organization
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Legal Business Name | GENERATION CLINICAL PARTNERS LLC
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 12/16/2020
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Provider Practice Location Address
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Address Line | 1251 COLLEGE AVE
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City | ALTON
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State | IL
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Zip | 62002-6735
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Country | US
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Telephone | 314-925-0903
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Fax | 314-764-2279
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Provider Business Mailing Address
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Address Line | PO BOX 14713
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City | BELFAST
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State | ME
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Zip | 04915-4042
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Country | US
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Telephone | 314-925-0903
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Fax | 314-764-2279
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MAE LIN
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Credential |
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Telephone | 314-925-0903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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